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Harrisburg State Hospital Closing
DEPARTMENT OF PUBLIC WELFARE
Office of Mental Health and Substance Abuse Services
SOUTHEAST REGION COMMUNITY MENTAL HEALTH SERVICES PLAN
PREAMBLE
The Pennsylvania Mental Health and Mental Retardation Act of 1966
establishes a county-administered community mental health service
system that requires a minimum array of services to be available
at the local level. The State Department of Public Welfare (DPW)
retains the responsibility to provide direct care at state psychiatric
facilities for persons who are acutely dangerous to themselves or
others, who retain little impulse control, or who have complicating,
co-occurring conditions which require longer-term inpatient care.
Over the last 30 years, reliance on state mental hospitals for the
care and treatment of persons with severe and long-term mental illness
has been dramatically reduced. Many persons have been released from
or diverted from institutions as a result of the development of
new drugs and treatments, and the gradual increase in availability
of services based on the Community Support Program (CSP) model.
A basic tenet of the CSP model is that the community is the preferred
locus for mental health treatment and support. Inpatient hospitalization
care is designated for evaluation and short-term stabilization,
except for the small number of people who need longer-term hospitalization.
Both experience and research have substantiated the effectiveness
of a comprehensive community support system. Studies conducted by
the National Institute for Mental Health, the Center for Mental
Health Services and the University of Pennsylvania have concluded
that comprehensive community support systems reduce the reliance
on hospitalization and improve the level of functioning, quality
of life and satisfaction of persons with severe mental illness.
Historically, in Pennsylvania, as in other states, the major barrier
to developing a comprehensive community support system has been
the shortage of funding to build the support and rehabilitative
programs needed in the community to meet the needs of persons capable
of being discharged or diverted from state hospitals.
Over the last seven years, the Pennsylvania Office of Mental Health
and Substance Abuse Services has undertaken a number of initiatives
to re-orient the focus of service delivery away from reliance on
large institutions towards community care for persons with severe,
disabling mental illness. These initiatives include consolidating
and closing some state hospitals (Philadelphia, Woodville, Somerset,
Eastern and Farview), implementing the Community Hospital Integration
Project Programs (CHIPPs) and consolidating the community and state
hospital budget appropriations. These initiatives have resulted
in eliminating over 3200 filled state hospital beds from June 30,
1990 through January 1, 1998, and increasing the county mental health
appropriation to $85.9 million. The current plan, as discussed below,
continues the previous initiatives and increases the Southeast Counties’
mental health “grant” appropriation between fiscal years
1997-98 through 2001-2002 by more than $37 million.
Discussion around this initiative began in 1994 when the Secretary
for the Department of Public Welfare appointed a Southeast Region
Planning Task Force and charged it with developing a 5-year plan
to integrate the resources of Haverford and Norristown State Hospitals
with community mental health programs. The group was comprised of
equal numbers of mental health consumers, families of persons with
mental illness and mental health professionals. The Task Force examined
the demographics of the state hospital population and reviewed financial
data from the state hospitals and the county programs. Each county
developed a five-year CHIPPs plan.
In a final report, dated November, 1994, the Task Force recommended
consolidating Haverford and Norristown State Hospitals onto one
campus and transferring current state hospital funds to county programs
to create a region-wide ‘community-based services system which
implements each county’s five-year CHIPP proposal. The recommendations
also included developing and funding specialized treatment centers.
In January, 1997, Mr. Charles Curie, Deputy Secretary for the Office
of Mental Health and Substance Abuse Services, convened the Southeast
Region Mental Health Steering Committee with membership consisting
of a mental health consumer representative, a family representative,
and the mental health administrator from each of the five Southeast
counties. Mr. Curie reviewed the recommendations of the 1994 Task
Force with the newly appointed committee. The Steering Committee
confirmed the validity of the previous Task Force’s recommendations.
The Steering Committee, on March 7, 1997 recommended consolidating
the two hospitals and transferring current state hospital funding
to county programs in order to develop a comprehensive community-based
services system. Mr. Curie agreed that the $97 million supporting
the two hospitals would be maintained in the southeast mental health
system. The subsequent decision and announcement by the Department
to consolidate the two hospitals by closing Haverford and discharging
people from both hospitals beginning this fiscal year (FY 1997/98)
was the first major step in achieving the desired system change.
Purpose
This plan documents the actions planned and committed to by the
Department of Public Welfare, Office of Mental Health and Substance
Abuse Services to implement the recommendations of the Southeast
Region Mental Health Steering Committee pertaining to the development
of a comprehensive community-based mental health service system
in southeastern Pennsylvania.
Recommended Actions
• Consolidate Haverford and Norristown State Mental Hospitals.
• Transfer existing state hospital funds supporting the closing
hospital (Haverford State Hospital) to southeast county programs
to provide community placements and services to persons being discharged
from the two hospitals and to support development of a comprehensive
community based services system.
• Maintain the funding level of the consolidated hospital
(Norristown State Hospital) for the continued development of a comprehensive
mental health services system and transfer the funds to the county
programs consistent with Department approved county plans. The system
development may include designing regional programs to assist people
living in the southeastern area, including persons being discharged
and/or diverted from the hospital.
Action Steps
The following actions are being taken to initiate the Southeast
Steering Committee recommendations and subsequent Department plan:
• Close Haverford State Hospital by June 30, 1998.
• Conduct a comprehensive assessment process with all patients
at Haverford. This process will include a consumer-to-consumer assessment
completed by the Mental Health Association of Southeastern Pennsylvania;
a family-to-family interview conducted by the Alliance for the Mentally
Ill of Pennsylvania: and ongoing clinical assessment conducted by
the Haverford treatment team.
• Establish a Discharge/Transfer Planning Group (DTPG) to
review the results of the patient assessments and make recommendations
pertaining to the ongoing treatment and/or community placement needs
of the patients at Haverford. The DTPG will be comprised of consumer
advocates, family advocates, county mental health staff, and Haverford
clinical staff, including the attending psychiatrist and social
worker for each person and the Chief of Psychiatry and the Director
of Social Work. The Clinical Care Coordinator will convene the DTPG
and provide ongoing oversight of its function.
• Solicit formal plans from the five southeast counties delineating
the number of hospital beds to be closed and community mental health
services to be developed to meet identified patient needs for the
three year period following the closure of Haverford on June 30,
1998.
• Review each county’s plan to assure that timelines
for the development of the services and a proposed discharge date
have been identified for each patient. The DTPG will meet regularly
with each county to review progress and address issues pertaining
to program development, service provision, and discharge of each
patient.
• Engage those patients identified for community placement
during the current fiscal year (FY 1997/98) in active discharge
planning with the Haverford treatment team, the county program and
county service provider(s).
• Involve those patients identified for community placement
in subsequent fiscal years in the planning for their transfer to
Norristown. At Norristown, they will continue to participate in
active discharge planning with the Norristown treatment team, the
DTPG, and the county program.
• Transfer those patients identified as needing further long-term
inpatient treatment to Norristown for continued inpatient treatment.
The Department recognizes that each of these patient’s clinical
status may change and will require the Clinical Care Coordinator
to convene the DTPG to review the treatment needs of each patient
with his/her treatment team prior to scheduled commitment hearings
or, at least, quarterly. The county program liaison to Norristown
is a member of the DTPG, enabling the county program to develop
community-based services required to meet the individual’s
needs.
• Conduct patient transfers to Norristown and placements to
community programs with respect for each patient’s wishes
to the greatest degree possible. Patients and their families will
be invited to participate in their planning, transfer and placement
process.
• Provide an independent assessment at DPW expense for any
patient and/or family who disagrees with the recommended discharge
plan, including assessment of the individuals community readiness
or necessary community services. An independent expert acceptable
to DPW and the involved parties wilt provide the independent assessment.
• Transfer those patients going to Norristown through the
following protocol:
• Norristown clinical care team will visit each patient and
review his/her clinical record to identify the most appropriate
Norristown unit.
• Haverford clinical staff will review the patient’s
current treatment plan with Norristown clinical staff.
• Familiar staff will be assigned to assist each transferring
patient in packing and preparing for the move.
• Patients and family members will be invited to visit Norristown
prior to the scheduled move.
• Familiar staff and/or family members will escort the patient
to Norristown.
• The Clinical Care Coordinator and DTPG with appropriate
county participation will continue to monitor all Haverford patients
transferred to Norristown quarterly to determine if the patient’s
anticipated discharge date and recommended community services and
supports remain on target.
• DPW will provide funding to the county programs for closing
338 hospital beds and placing patients and developing a comprehensive
community- based service system for eligible individuals consistent
with the county’s plan submitted to and approved by the Department.
The Departments plan commits over $37 million to the county programs
on an annual basis at the conclusion of the five-year (FY 1997/98
through FY 2001-2002) plan period. The following table outlines
the amount of funding that will be granted to the county programs
in each of the years governed by the Department’s plan based
on the plans that the counties have submitted to DPW.
Fiscal Year Funds Committed for County Grants
FY1997/1998 $ 4,449,610
FY 1998/1999 $ 13,771,520
FY 1999/2000 $ 22,129,398
FY 2000/2001 $ 30,298,150
FY200I/2002 $ 37,731,561
• Provide a five-year grant allocation that specifies the
amount of funding for each county. The amounts to be granted will
be consistent with the plans submitted by each county. DPW will
notify county programs in writing of the amount of funding committed
to the grant allocation for each fiscal year. The grants will clearly
define the Department’s expectations and county responsibilities
specific to the grants. The Department’s requirements will
be consistent with the actions proposed by each county in its respective
plan, including the number of placements, resources to be developed
and timeframes identified. To the extent that counties can expedite
closing hospital beds due to more rapid community resource development,
DPW can allocate additional funds accordingly.
• Hold county programs accountable to complete the actions
proposed in their plans and funded by the Department. The Department
will monitor county compliance on a monthly basis and will work
with counties in addressing problems that may arise. The Department
reserves the right to decrease the amount of funding provided to
any county should the county not meet the performance requirements
identified in their plans and specified in the grant allocation.
In situations where a given county is not meeting the performance
requirements and funds must be reduced from the plan grant allocation,
the Department will solicit proposals from the other county programs
to apply for the available funds.
• Provide a five-year grant allocation commitment to each
county within 15 working days of the issuance of the Department’s
plan.
DPW/OMHSAS 3/98
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